May 4, 2020 -- A study at Columbia University Mailman School of Public Health found that long-term buprenorphine treatment is associated with improvements in health care outcomes. Compared to individuals who discontinued buprenorphine, those with continuous treatment had significantly lower rates of prescription opioid use and opioid-related events, including medically treated overdoses in the follow-up period. The results are published in the May issue of the journal Health Affairs.
"Buprenorphine is an effective medication for the treatment of opioid addiction, yet until now studies were not designed to establish a minimum duration of treatment for opioid use disorder needed to achieve improved clinical outcomes," said Hillary Samples, PhD, postdoctoral research fellow in the Department of Epidemiology, Columbia University Mailman School of Public Health. "As a result of limited evidence, health plans and care guidelines set potentially restrictive treatment standards."
The researchers analyzed health insurance claims data to compare patients with continuous buprenorphine treatment to those who discontinued 6-9 months after initiating medication with the goal of extending evidence from clinical trials, which are typically limited to 3 to 6-month periods. In addition, the National Quality Forum defines 180 days (6 months) as the minimum duration of pharmacotherapy for opioid use disorder treatment, and quality measures are often used by federal and state agencies or health plans to set treatment standards.
Compared to 4,433 adults who discontinued buprenorphine 6-9 months after beginning treatment, individuals with continuous treatment had significantly lower risk of all-cause inpatient (?52%) and emergency department (?26%) services, opioid-related hospital services (?128%), overdose events (?173%), and opioid prescriptions (?120%) as well as a significantly lower rate of prescription opioid use (?124%) in the follow-up period than in the treatment period.
The greatest decreases were found for overdose events, opioid-related inpatient and emergency department services and prescription opioids use. "The pattern of results indicates that longer-term buprenorphine treatment more effectively protects patients from adverse clinical outcomes," said Samples.
"Overall, our findings suggest a need for broader efforts to increase long-term access to care and extend standards and guidelines for minimum treatment duration," noted Samples. "While guidelines can lead to improvements in care and patient outcomes, they can also have unintended consequences, such as forming the basis for managed care practices that limit access to longer-term treatment."
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Co-authors are Arthur Robin Williams, Department of Psychiatry, Columbia University Irving Medical Center; Stephen Crystal, Rutgers University; and Mark Olfson, Columbia Mailman School of Public Health and Department of Psychiatry, Columbia University Irving Medical Center.
The study was supported by the National Institute on Drug Abuse (T32 DA031099, L30 DA046889, K23 DA044342, R01 DA047347), and the Agency for Healthcare Research and Quality ( R18 HS023258 , U19 HS021112).
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the seventh largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master's and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu.
Journal
Health Affairs